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PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1494-1495

A New Look at Meningomyeloceles

Gordon Worley, MD
Neurodevelopmental Pediatrics
Myelodysplasia (Spina Bifida) Clinic
Duke University Medical Center
Durham, NC 27710, USA

The first 20% of the full text of this article appears below.

To the Editor.—

Rintoul et al1 reviewed the records of 297 patients born after 1983 with an open meningomyelocele whose lesion was closed at their hospital and who were subsequently followed in their spina bifida clinic, to describe clinical outcomes. The authors are to be commended for documenting the results of conscientious and comprehensive care. I have, however, reservations about using their cross-sectional survey for their stated purpose "to serve as a comparison group ... to assess the efficacy" of in utero (fetal) surgery for meningomyelocele.

First, I do not believe that their rate of placement of a ventriculoperitoneal (VP) shunt for treatment of hydrocephalus (81%) or that from any cross-sectional survey can serve as a "gold standard" against which the rate of developing hydrocephalus after fetal surgery can be compared. The decision about who among infants with spina bifida and hydrocephalus requires placement of a VP shunt is arbitrary and the prevalence of shunting varies from clinic to clinic. For instance, in a cohort study performed by our clinic some years ago, we found that 95% of patients had been shunted.2 Likewise, there is a significant difference in the rate of VP shunt placement in the 2 series of patients who underwent fetal surgery for meningomyelocele, as acknowledged by the authors. In the series of patients who had fetal surgery reported from the authors’ institution, reported by Sutton et al,3 only 1 of 9 (11%) had VP shunt placement, but Bruner et al,4 doing fetal surgery on patients at a slightly more advanced gestational age, shunted 59%. We now follow . . . [Full Text of this Article]


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